Responsible for investigation, documentation and processing of multiple types of other insurance claims while meeting or exceeding designated production and quality standards. Conducts outbound calls to insurers to verify other coverage information provided to us by the member, CMS, or other entities. Document and maintain COB data in source system.

To successfully perform the role, the COB Specialist must have a comprehensive understanding of various regulations as related to COB and subrogation, and must complete all duties with strict regard to policies and procedures.
Completes all duties with strict regard to policies and procedures set forth by Enrollment Services Manager, Centers for Medicare and Medicaid Services (CMS), Pennsylvania Department of Welfare (DPW), and Pennsylvania Insurance Department (PID).
Responsible for responding to internal customer inquiries and resolving issues to meet or exceed customer requirements. In addition, the Coordination of Benefits Specialist I should maintain a high level of interaction with the other internal departments.

Responsibilities:

Ability to interpret and apply complex regulations as mandated by CMS, DPW, and PID as related to coordination of benefits, subrogation, and Medicare.

Accurately recognizes and reports trends or issues identified from daily work and works in partnership with leadership to develop and implement solutions.
Consistently meets departmental production standards
Consistently meets departmental quality standards

Demonstrates strong knowledge of claims processing, ensures claims and associated holds impacted by other insurance are properly researched and resolved in a timely fashion. Recognizes and takes action to ensure timely reprocessing of claim(s).

Identifies updates required to external systems, state or federal, and takes action to ensure the appropriate and accurate update is made in a timely manner. Reviews and works any submission rejection in a timely manner and consistently meets departmental goals related to submission acceptance.

Identify areas of opportunity to improve service to members and/or reduce member impact. Initiate outreach efforts, to members, other carriers, or clients, when deemed appropriate or necessary to gather necessary information to resolve issues or appropriate resolve case..

Interface with internal and external customers to assure resolution of inquiries and concerns. Access, investigate, and resolve issues to achieve customer satisfaction, seeking to achieve one touch resolution with all departmental requests for assistance. .

Investigates all possible instances of other insurance for all lines of business appropriately and accurately utilizing internal and external systems to verify existence of other insurance. Appropriately and accurately applies NAIC, Medicare, and other state and/or federal regulations to determine proper order of benefits.

Processes member requests to update other insurance coverage, including from surveys, phone calls, custody court order requests, or other member correspondence. Ensures request is fully processed, documented, and resolved.

Properly updates member record to reflect primary or secondary coverage based on findings. Ensures documentation is accurate, clear, and thorough.

UPMC VALUES

At UPMC, our shared goal is to create a cohesive, positive, experience for our employees, patients, health plan members, and community. If you too are driven by these values, you may be a great fit at UPMC!

UPMC provides a total rewards package that can help you achieve the goals you have for your career and your personal life. Whether you want to learn a new skill through a training course, reach personal health and wellness targets, become more involved in your community, or follow a career path that provides you with the right experience to be successful, UPMC can help you get to where you want to be.

Responsible for investigation, documentation and processing of multiple types of other insurance claims while meeting or exceeding designated production and quality standards. Conducts outbound calls to insurers to verify other coverage information provided to us by the member, CMS, or other entities. Document and maintain COB data in source system.

To successfully perform the role, the COB Specialist must have a comprehensive understanding of various regulations as related to COB and subrogation, and must complete all duties with strict regard to policies and procedures.
Completes all duties with strict regard to policies and procedures set forth by Enrollment Services Manager, Centers for Medicare and Medicaid Services (CMS), Pennsylvania Department of Welfare (DPW), and Pennsylvania Insurance Department (PID).
Responsible for responding to internal customer inquiries and resolving issues to meet or exceed customer requirements. In addition, the Coordination of Benefits Specialist I should maintain a high level of interaction with the other internal departments.

Responsibilities:

Ability to interpret and apply complex regulations as mandated by CMS, DPW, and PID as related to coordination of benefits, subrogation, and Medicare.

Accurately recognizes and reports trends or issues identified from daily work and works in partnership with leadership to develop and implement solutions.
Consistently meets departmental production standards
Consistently meets departmental quality standards

Demonstrates strong knowledge of claims processing, ensures claims and associated holds impacted by other insurance are properly researched and resolved in a timely fashion. Recognizes and takes action to ensure timely reprocessing of claim(s).

Identifies updates required to external systems, state or federal, and takes action to ensure the appropriate and accurate update is made in a timely manner. Reviews and works any submission rejection in a timely manner and consistently meets departmental goals related to submission acceptance.

Identify areas of opportunity to improve service to members and/or reduce member impact. Initiate outreach efforts, to members, other carriers, or clients, when deemed appropriate or necessary to gather necessary information to resolve issues or appropriate resolve case..

Interface with internal and external customers to assure resolution of inquiries and concerns. Access, investigate, and resolve issues to achieve customer satisfaction, seeking to achieve one touch resolution with all departmental requests for assistance. .

Investigates all possible instances of other insurance for all lines of business appropriately and accurately utilizing internal and external systems to verify existence of other insurance. Appropriately and accurately applies NAIC, Medicare, and other state and/or federal regulations to determine proper order of benefits.

Processes member requests to update other insurance coverage, including from surveys, phone calls, custody court order requests, or other member correspondence. Ensures request is fully processed, documented, and resolved.

Properly updates member record to reflect primary or secondary coverage based on findings. Ensures documentation is accurate, clear, and thorough.

UPMC VALUES

At UPMC, our shared goal is to create a cohesive, positive, experience for our employees, patients, health plan members, and community. If you too are driven by these values, you may be a great fit at UPMC!

UPMC provides a total rewards package that can help you achieve the goals you have for your career and your personal life. Whether you want to learn a new skill through a training course, reach personal health and wellness targets, become more involved in your community, or follow a career path that provides you with the right experience to be successful, UPMC can help you get to where you want to be.

WORKING HERE

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